[Screening program for tuberculosis among international exchange students in the Department of Isère]. / Dépistage de la tuberculose chez les étudiants étrangers en échange international en Isère.

INTRODUCTION: France is a low-incidence country for tuberculosis (TB). Consequently screening is focused on high-risk populations, in particular migrants. The aim of this study was to evaluate the epidemiology of TB among international exchange students in the Department of Isère and the screening programs used. METHODS: We carried out an organizational audit based on interviews with physicians involved in the management of TB in Isère. We conducted a retrospective descriptive study based on a case series of foreign students treated for TB from 2003 to 2013 inclusively. RESULTS: Forty-six international exchange students were treated for active TB during this time, representing an average incidence of 284/100,000. Two thirds of our studied population were Africans, 72% were asymptomatic at the time of screening. A quarter of our cohort developed TB after the initial screening. Thirty-one cases were confirmed bacteriologically, mainly through bronchoscopy. Outcome (radiological and clinical) on quadruple therapy was satisfactory in all patients. Two patients relapsed, one of them with multi-drug resistant TB. CONCLUSION: Our work confirms that international exchange students are a population at high risk of TB and that screening of this population is essential. The significant number of active TB cases diagnosed after the initial screening stresses the importance of diagnosis and follow up of patients with latent TB infection.

[Cavitating nodules in a 40-year-old non-smoking woman: a very particular tumour]. / Nodules pulmonaires excavés chez une femme de 40 ans non fumeuse: une tumeur très particulière.

INTRODUCTION: EML4-ALK fusion gene, is found in 3 to 5 % of lung adenocarcinoma and can be targeted by tyrosine-kinase inhibitor (TKI) with impressive therapeutic results. CASE REPORT: We report the case of a non-smoking 40-year-old woman, diagnosed with metastatic poorly differentiated papillary adenocarcinoma of the lung harbouring the ALK fusion gene. After six cycles of first line chemotherapy with cisplatine-vinorelbine followed by maintenance treatment with erlotinib, the patient achieved a partial response. After disease progression, the patient was included in a trial comparing crizotinib with a classic 2nd line chemotherapy. After 1 month of crizotinib, the patient's condition improved. CT of the chest showed a near-total regression of bilateral pulmonary nodules replaced by pulmonary cysts. CONCLUSION: We report in this case a dramatic improvement with near-complete vanishing of pulmonary nodules replaced by pulmonary cysts in a patient treated with crizotinib. This case reminds us of the potential importance of evaluating the molecular diagnosis in lung cancers and especially in adenocarcinoma of the lung.